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Name of treatment regimen

University Hospitals/Ireland Cancer Center

Sickle Cell Inpatient Treatment Guidelines

Supportive Care

Sickle Cell Guidelines
• If patient is hypovolemic on admission, hydrate with Normal Saline @ 300 - 500 • If patient is euvolemic on admission or becomes euvolemic after hydration, hydrate with D5W1/2NS at 75-125 ml/hr continuously.
All patients on admission should have the following parameters obtained: • CBC with diff and reticulocyte count, basic metabolic and hepatic panels. • Women: urine beta-HCG • Blood cultures, urinalysis with culture if needed
• Transfuse PRBC’s if the Hgb drops >3 g below baseline. • Transfuse PRBC’s for symptomatic anemia i.e. shortness of breath, dyspnea on exertion or orthostasis. Sickle Cell Crisis is NOT a symptom of anemia.
Pain Medications
• All narcotic bolus doses should be given as IVPB • If there is no IV access, analgesics may be given IM or SQ. • If the patient is on chronic long acting narcotics, continue the same. • For initial pain relief give Morphine 5 - 10 mg IV and repeat every 1 hr prn pain until pain improves or Dilaudid 1 – 2 mg IV and repeat every 2 hr prn pain until pain improves. • When patient has obtained adequate pain relief with bolus narcotics within the first 2 hours of admission begin PCA with morphine at 1 - 2 mg demand or dilaudid at 0.2 – 0.4 mg demand with a 6 min lock out. • If the patient is not on chronic long acting narcotics consider adding a basal rate • Breakthrough pain medications to be given equivalent to a 1 hour demand if needed. Give one time doses. If frequent breakthrough doses needed, increase PCA demand dose. • If no contraindications to NSAID such as renal dysfunction, GI bleed, PUD or GERD may add ketorolac 30 mg IV every 6 hrs x a maximum of 5 day. • Re-assess frequently. Increase PCA doses by 25% if needed. MD Signature: ____________________Printed Name: ____________________Beeper:________ Date order written__________________ University Hospitals/Ireland Cancer Center

Sickle Cell Inpatient Treatment Guidelines

Supportive Care

Sickle Cell Guidelines

• Incentive spirometry at bedside • Routine use of supplemental oxygen is not recommended unless oxygen
Ancillary Medications

• For itching: diphenhydramine 25-50 mg po every 4-6 hrs or hydroxyzine 25-50 • Antibiotics, other home meds as needed as needed.
Chronic Care
• Ferritin concentration if not drawn in the previous 12 months • Echocardiogram if not done in the previous 24 months • Pneumococcal, meningococcal and influenza vaccinations if not previously given • Pulmonary Hypertension consult if needed.
Special Situations
• Acute chest syndrome presenting as new infiltrates, hypoxia, and chest pain may require exchange transfusion and a transfusion medicine consult should be obtained. For mild symptoms PRBC’s should be given. MD Signature: ____________________Printed Name: ____________________Beeper:________ Date order written__________________


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Conform artikel 4.2.2. van de Wereld Anti-Doping Code zullen alle verboden stoffen worden beschouwd als “specifieke stoffen” behalve stoffen in de groepen S1, S2, S4.4, S4.5, en S6.a en de Verboden Methoden M1, M2 en M3. Stoffen en methoden die te allen tijde zijn verboden (zowel binnen wedstrijdverband als buiten wedstrijdverband) Verboden stoffen S0. Peptide hormonen, groeifactoren en verw

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DOB (or place label here)_________________________ Emergency Department Acute Chest Pain Protocol Date __________________________ Time _____________________ ED Physician Name:_______________________________________ Telephone Number________________________________________ ED MD Pager#____________________________________________ Referring/Follow-up Physician Name:_____________________

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